Exercise Rehabilitation in Knee Osteoarthritis

Introduction: Osteoarthritis (OA) is a joint condition that affects elderly individuals. Therapeutic
exercises have several clinical benefits that can be applied by different types, both in the land and in
the aquatic environment. OA is characterized by wear of the cartilage that overlaps the articular
surfaces, with formation of fibrillation and fissure areas, cysts, subchondral bone sclerosis, and even
formation of osteophytes at the joint edges. Among the different types of exercises used in the
rehabilitation of knee OA, closed kinetic chain (CKC) exercises are shown to be more functional, in
addition to providing a better restoration of muscle strength without damaging the patellofemoral joint.
Objectives: To compare the effectiveness of closed kinetic chain (CKC) exercises performed on the
ground and in the swimming pool in women with knee osteoarthritis (KOA).
Study Design: Double-Blind Randomized Clinical Trial.
Place and Duration of the Study: Clinical School of Physiotherapy of Ulbra Torres, from March 2015
to June 2017.
Methodology: Thirty-four women with grade 1 and 2 knee knee OA were allocated into two groups.
One group received treatment with CKC exercises on the ground (n = 17) and the other group had the
same exercises performed in the swimming pool (n = 17) for a period of two months, three times a
week, totaling 24 sessions. Subjects were initially assessed prior to randomization, after 12 sessions,
after 24 sessions and 3 months after the end of the protocol. The following variables were evaluated:
pain, knee joint mobility, hamstring flexibility, hamstring and quadriceps muscle strength and
functionality.
Results: There was an improvement in hamstring flexibility with 12 sessions in the pool group and at
the end of the protocol in both groups (P<.05). The range of motion of knee flexion increased in both
study groups after the intervention (P<.05). The pool group demonstrated a reduction of this gain in
the follow-up. Pain decreased similarly in both groups (P<.05). The pool group showed an initial
quadriceps strength and left hamstring strength lower than the ground group. However, at the end of
the protocol, both groups improved muscle strength in both knees (P<.05). The Lequesne and
WOMAC scores reduced significantly with 12 sessions in both groups (P<.05), remaining likewise in
the follow-up.
Conclusion: Therapeutic exercises in different forms and locations present several benefits of pain
reduction, improved joint mobility, increased muscle strength and improved function in patients with
knee osteosarthritis. There was an increase in quadriceps and left hamstring muscle strength in the
CKC Pool group, possibly because this group had predominantly the left knee as the most affected
and, therefore, with a significantly higher pre-intervention deficit. Both groups increased quadriceps
and right hamstring strength with 24 sessions. Further studies should be performed to confirm these
findings.